Adolescents have some of the highest rates of risk behaviors of all age groups and health behaviors developed in adolescence can persist into adulthood. These behaviors carry significant risks for subsequent disease, disability, and healthcare burden. Despite these risks, health risk screening in primary care is infrequently performed and results are rarely followed by targeted intervention. In response to the need for screening-linked interventions, our study team has developed a web-based, electronic Personalized Motivational Feedback tool which we refer to as "Check Yourself." Based on motivational interviewing, a technique to mobilize personal change, Check Yourself is designed to promote healthy choices for the multiple behaviors relevant to adolescents as well as to provide information to providers to promote discussions around health behaviors between providers and adolescents. Building on electronic health interventions, primary care providers can play an essential role in helping adolescents to make healthy behavior choices. Emerging evidence suggests that the consistency of preventive counseling can be increased through provider training and the provision of screening tools; yet, we know very little about the quality of such counseling, and if it impacts outcomes that are important to adolescent patients themselves. This study is a stepped-wedge, controlled trial comparing the effectiveness of an interactive adolescent-centered training for primary care providers (I-ACT) and Check Yourself to usual care. This study will take place in six pediatric practices. The purpose of this study is to determine whether this system of interventions (i.e., I-ACT, Check Yourself, and the summary report) is more effective than usual care in reducing health risk behaviors, improving adolescent motivation for health, and improving quality of care among adolescents receiving primary health care services.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
302
University of Washington
Seattle, Washington, United States
Number of Health Risk Behaviors
The risk behavior scale includes 22 values: 0 (min) to 21 (max). Higher scores indicate a worse outcome. Endorsement of any of the following counts as 1 (moderate risk) or 2 (high risk) on the scale depending on response and participant: ≥2 sugar-sweetened beverages consumed during typical day; ≤3 servings fruits/vegetables consumed during typical day; ≤3 days with 60+ minutes exercise during typical week; texting while driving in past 3 months; ≤7 hrs of sleep during typical night; not "always" using seatbelt; not "always" using helmet when bicycling; having driven under the influence of substances; tobacco use; days alcohol consumption in last 30 days (risk based on age) and/or number of drinks per drinking episode (risk based on age \& sex); days marijuana consumption in last 30 days (risk based on age) and/or other drug use in past 3 months; not using birth control during last sexual intercourse and/or not "always" using a condom; \& score of ≥10 on PHQ-9 depression.
Time frame: 3 month
Sweetened Beverage Consumption
Adolescent self-reported number of sweetened beverages consumed in a typical day in the past 3 months. The sweetened beverages scale includes 4 values: 0 (min), 1, 2, or 3+ (max) sweetened beverages per day. Higher scores mean a worse outcome.
Time frame: 3 month
Fruit and Vegetable Consumption
Adolescent self-reported number of fruits and vegetables consumed in a typical day in the past 3 months. The fruits and vegetables scale includes 6 values: 0 (min), 1, 2, 3, 4, or 5+ (max). Higher scores mean a better outcome.
Time frame: 3 month
Physical Activity
Adolescent self-reported number of days with \>60 minutes of physical activity in an average week in the past 3 months. The physical activity scale includes 8 values: 0 (min) to 7 (max). Higher scores mean a better outcome.
Time frame: 3 month
Sleep
Adolescent self-reported hours of sleep on a typical night in the past 3 months. The sleep scale includes 13 values: 0 (min) to 12+ (max) hours of sleep per night. Higher scores mean a better outcome.
Time frame: 3 month
Alcohol Consumption (Frequency)
Adolescent self-reported number of days of alcohol consumption in the past month. Alcohol frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome.
Time frame: 3 months
Alcohol Consumption (Quantity)
Adolescent self-reported number of drinks during a typical drinking episode in the prior month. The alcohol quantity scale includes 16 values from 0 (min) to 15+ (max). Higher score means a worse outcome.
Time frame: 3 months
Marijuana Consumption
Adolescent self-reported number of days using marijuana in the past month. The marijuana frequency scale includes 31 values: 0 (min) to 30 (max) days in the past month. Higher scores mean a worse outcome.
Time frame: 3 months
Other Drug Consumption
Adolescent self-reported use of other drugs in the past 3 months. The other drug score includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 months
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire (PHQ-9) in the past 2 weeks. The PHQ-9 depression scale includes 28 values: 0 (min) to 27 (max). Higher scores mean a worse outcome.
Time frame: 3 month
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in the past 3 months. The seatbelt use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome.
Time frame: 3 month
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in the past 3 months. The helmet use scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a better outcome.
Time frame: 3 months
Texting While Driving
Adolescent self-reported endorsement of texting while driving in the past 3 months. This question is only asked among adolescents who drive a car. The texting while driving scale includes 4 values: 1=never (min), 2=sometimes, 3=usually, or 4=always (max). Higher scores mean a worse outcome.
Time frame: 3 months
Condom and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse. Two questions were used for this category. These questions were asked only to sexually active youth. The condom use scale includes 4 values: 1=always (min), 2=often, 3=sometimes, 4=never (max). Higher scores mean a worse outcome. The birth control scale includes 2 values: 0=no (min), 1=yes (max). Higher scores mean a better outcome.
Time frame: 3 months
Driving With Impairment
Adolescent self-reported driving under the influence of a substance in the past 3 months. This question was asked only of adolescents who drive a car. The driving with impairment scale includes 2 values: 0=no (min) and 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 month
Adolescent Satisfaction With Care
Adolescent satisfaction with care is assessed using one item adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. The CAHPS scale includes 10 values: 1 (min) to 10 (max). Higher scores mean a better outcome.
Time frame: 1-day
Caregiver Satisfaction With Care
Caregiver satisfaction with care is assessed using the four items adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) measure at 1-day follow-up. Scores on this scale range from 3 (min) to 22 (max) with higher scores indicating higher satisfaction with care.
Time frame: 1-day
Adolescent Perception of Patient-Centeredness
The total score on the Consultation and Relational Empathy measure (CARE) is used to assess adolescent self-report of perceived patient-centeredness from their primary care provider. Scores on the scale range from 10 (min) to 50 (max) with higher scores indicating a better outcome.
Time frame: 1 day
Tobacco Use
Adolescent self-reported tobacco use in the past 3 months. The tobacco use scale includes 2 values: 0=no (min) or 1=yes (max). Higher scores mean a worse outcome.
Time frame: 3 months
Percent of Risk Behaviors Counseled on During Primary Care Appointment
Percent of adolescent-reported health risk behaviors discussed with the healthcare provider during the primary care visit adjusted for the total number of health risk behaviors reported at baseline.
Time frame: 1 day
Number of Health Risk Behaviors
Adolescent total count health-risk behaviors at 6 month follow-up including: During typical day: ≥2 sugar-sweetened beverages consumed and ≤3 servings fruits/vegetables consumed; ≤3 days with 60+ minutes exercise during typical week; having texted while driving in past 3 months; ≤7 hours of sleep during typical night; not "always" using seatbelt; not "always" using helmet when bicycling; having driven under the influence of substances; tobacco use; days of alcohol consumption in last 30 days (risk based on age: ≥1 day/30 days (ages 13-15), ≥2 days/30 days (ages 16-17), or ≥3 days/30 days (age 18))and/or number of drinks per drinking episode (risk based on age and sex: ≥3 (Girls 13-17; Boys 13), ≥4 (Girls 18; Boys 14-15), or ≥5 (Boys 16-18)); days marijuana consumption in 30 day (risk based on age) and/or other drugs use in past 3 months; not using birth control during last sexual intercourse and/or not "always" using a condom; and score of ≥10 on PHQ-9.
Time frame: 6 month
Number of Health Risk Behaviors
Adolescent total count health-risk behaviors at 12 month follow-up including: During typical day: ≥2 sugar-sweetened beverages consumed and ≤3 servings fruits/vegetables consumed; ≤3 days with 60+ minutes exercise during typical week; having texted while driving in past 3 months; ≤7 hours of sleep during typical night; not "always" using seatbelt; not "always" using helmet when bicycling; having driven under the influence of substances; tobacco use; days of alcohol consumption in last 30 days (risk based on age: ≥1 day/30 days (ages 13-15), ≥2 days/30 days (ages 16-17), or ≥3 days/30 days (age 18))and/or number of drinks per drinking episode (risk based on age and sex: ≥3 (Girls 13-17; Boys 13), ≥4 (Girls 18; Boys 14-15), or ≥5 (Boys 16-18)); days marijuana consumption in 30 day (risk based on age) and/or other drugs use in past 3 months; not using birth control during last sexual intercourse and/or not "always" using a condom; and score of ≥10 on PHQ-9.
Time frame: 12 month
Sweetened Beverage Consumption
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Adolescent self-reported sweetened beverages consumed in a typical day in past 3 months
Time frame: 6 month
Sweetened Beverage Consumption
Adolescent self-reported sweetened beverages consumed in a typical day in past 3 months
Time frame: 12 month
Fruit and Vegetable Consumption
Adolescent self-reported fruits and vegetables consumed in a typical day in past 3 months
Time frame: 6 month
Fruit and Vegetable Consumption
Adolescent self-reported fruits and vegetables consumed in a typical day in past 3 months
Time frame: 12 month
Physical Activity
Adolescent self-reported days with \>60 minutes of physical activity in an average week in past 3 months
Time frame: 6 month
Physical Activity
Adolescent self-reported days with \>60 minutes of physical activity in an average week in past 3 months
Time frame: 12 month
Sleep
Adolescent self-reported hours of sleep on a typical night in past 3 months
Time frame: 6 month
Sleep
Adolescent self-reported hours of sleep on a typical night in past 3 months
Time frame: 12 month
Alcohol Consumption
Adolescent self-reported number of days of alcohol consumption and drinks during typical drinking episode in the prior month
Time frame: 6 month
Alcohol Consumption
Adolescent self-reported number of days of alcohol consumption and drinks during typical drinking episode in the prior month
Time frame: 12 month
Marijuana and/or Other Drug Consumption
Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months
Time frame: 6 month
Marijuana and/or Other Consumption
Adolescent self-reported number of days using marijuana in the past month and/or other drugs used in past 3 months
Time frame: 12 month
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire in past 2 weeks
Time frame: 6 month
Depression
Adolescent self-reported depression as measured on the nine item Patient Health Questionnaire in past 2 weeks
Time frame: 12 month
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in past 3 months
Time frame: 6 month
Seatbelt Use
Adolescent self-reported frequency of seatbelt use in a car in past 3 months
Time frame: 12 month
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in past 3 months
Time frame: 6 month
Helmet Use
Adolescent self-reported frequency of helmet use while bicycling in past 3 months
Time frame: 12 month
Texting While Driving
Adolescent self-reported endorsement of texting while driving in past 3 months
Time frame: 6 month
Texting While Driving
Adolescent self-reported endorsement of texting while driving in past 3 months
Time frame: 12 month
Condom Use and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse
Time frame: 6 month
Condom Use and/or Birth Control Use
Adolescent self-reported condom use with sexual intercourse in the past 3 months and/or use of birth control at last sexual intercourse
Time frame: 12 month
Driving With Alcohol Impairment
Adolescent self-reported driving under the influence of a substance
Time frame: 6 month
Driving With Alcohol Impairment
Adolescent self-reported driving under the influence of a substance
Time frame: 12 month
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk behaviors identified at baseline adjusted for baseline number of health risk behaviors.
Time frame: 3 month
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk
Time frame: 6 month
Interval Receipt of Care Questionnaire
Dichotomous variable indicating receipt of any follow-up care to address risk
Time frame: 12 month
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 1 day
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 3 month
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 6 month
Readiness to Change Ruler Questionnaire
Assessment of adolescent reported motivation to change overall health using a Readiness to Change Ruler.
Time frame: 12 month
Tobacco Use
Adolescent self-reported tobacco use in past 3 months
Time frame: 6 month
Tobacco Use
Adolescent self-reported tobacco use in past 3 months
Time frame: 12 month